Skip to main content
SpringerLink
Log in

How does magnetically controlled growing rods insertion affect sagittal alignment in ambulatory early onset scoliosis patients?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The importance of sagittal alignment restoration in early onset scoliosis (EOS) management has rarely been investigated to date. The aim was to report the influence of magnetically controlled growing rods (MCGR) insertion on the sagittal alignment of EOS patients.

Methods

All consecutive ambulatory patients operated with MCGR rods between 2011 and 2018 were retrospectively included in four institutions. Standing biplanar radiographs were performed preoperatively, in the early postoperative period and at latest follow-up. Global and local sagittal parameters, spinal global shape and harmony were investigated.

Results

A total of 37 ambulatory EOS patients were included (mean age at surgery 8.5 (± 2) years). 70% had a balanced construct postoperatively. Both MaxTK (− 17°, p = 0.02) and MaxLL (− 15°, p = 0.001) were significantly reduced, particularly at the instrumented levels. The number of vertebrae included in the lumbar lordosis significantly increased (+ 2 levels, p = 0.02), as well as the thoraco-lumbar inflexion point (+ 2 levels, p < 0.001) and the kyphosis apex (+ 1 level, p < 0.001). Overall mechanical failure rate was 40.5%, and radiological PJK was observed in 43% of the patients, with 11 remaining asymptomatic. Patients with initial hyperkyphosis (> 50°) developed more complications (62% vs. 28%, p = 0.04).

Conclusion

MCGR insertion flattened the spine in EOS, at both instrumented and non-instrumented levels. Overall spinal harmony was modified, with a cranial shift of the thoraco-lumbar inflexion point and the thoracic kyphosis apex, associated with a lengthening of the lumbar lordosis. The rate of complication remained high, some explanations being found in the radiological changes reported such as the preoperative location of the TK apex.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Karol LA (2019) The natural history of early-onset scoliosis. J Pediatr Orthop 39 (Issue 6, Supplement 1 Suppl 1): S38‑43

  2. Akbarnia BA, Pawelek JB, Cheung KMC, Demirkiran G, Elsebaie H, Emans JB et al (2014) Traditional growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a case-matched 2-year study. Spine Deform 2(6):493–497

    Article  Google Scholar 

  3. Sankar WN, Acevedo DC, Skaggs DL (2010) Comparison of complications among growing spinal implants. Spine 35(23):2091–2096

    Article  Google Scholar 

  4. Shah SA, Karatas AF, Dhawale AA, Dede O, Mundis GM, Holmes L et al (2014) The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine 39(22):E1311-1317

    Article  Google Scholar 

  5. Watanabe K, Uno K, Suzuki T, Kawakami N, Tsuji T, Yanagida H et al (2016) Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis. Clin Spine Surg 29(8):E428-433

    Article  Google Scholar 

  6. Atici Y, Akman YE, Erdogan S, Sari S, Yavuz U, Carkci E et al (2015) The effect of growing rod lengthening technique on the sagittal spinal and the spinopelvic parameters. Eur Spine J 24(6):1148–1157

    Article  Google Scholar 

  7. Pan A, Hai Y, Yang J, Zhang Y, Zhang Y (2018) Upper instrumented vertebrae distal to T2 leads to a higher incidence of proximal junctional kyphosis during growing-rod treatment for early onset scoliosis. Clin Spine Surg 31(7):E337–E341

    Article  Google Scholar 

  8. Polly DW, Ackerman SJ, Schneider K, Pawelek JB, Akbarnia BA (2016) Cost analysis of magnetically controlled growing rods compared with traditional growing rods for early-onset scoliosis in the US: an integrated health care delivery system perspective. Clinicoecon Outcomes Res 8:457–465

    Article  Google Scholar 

  9. Aslan C, Olgun ZD, Ayik G, Karaokur R, Ozusta S, Demirkiran GH et al (2019) Does decreased surgical stress really improve the psychosocial health of early-onset scoliosis patients? A comparison of traditional growing rods and magnetically-controlled growing rods patients reveals disappointing results. Spine 44(11):E656–E663

    Article  Google Scholar 

  10. Thakar C, Kieser DC, Mardare M, Haleem S, Fairbank J, Nnadi C (2018) Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis. Eur Spine J 27(9):2062–2071

    Article  Google Scholar 

  11. Ilharreborde B (2018) Sagittal balance and idiopathic scoliosis: does final sagittal alignment influence outcomes, degeneration rate or failure rate? Eur Spine J 27(Suppl 1):48–58

    Article  Google Scholar 

  12. Akbarnia BA, Cheung K, Noordeen H, Elsebaie H, Yazici M, Dannawi Z et al (2013) Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine 38(8):665–670

    Article  Google Scholar 

  13. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR et al (2014) Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Jt Surg Am 96(16):1359–1367

    Article  Google Scholar 

  14. Maillot C, Ferrero E, Fort D, Heyberger C, Le Huec J-C (2015) Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements : Keops (®). Eur Spine J 24(7):1574–1581

    Article  CAS  Google Scholar 

  15. Gutman G, Labelle H, Barchi S, Roussouly P, Berthonnaud É, Mac-Thiong J-M (2016) Normal sagittal parameters of global spinal balance in children and adolescents: a prospective study of 646 asymptomatic subjects. Eur Spine J 25(11):3650–3657

    Article  Google Scholar 

  16. Mangione P, Gomez D, Senegas J (1997) Study of the course of the incidence angle during growth. Eur Spine J 6(3):163–167

    Article  CAS  Google Scholar 

  17. Schroerlucke SR, Akbarnia BA, Pawelek JB, Salari P, Mundis GM, Yazici M et al (2012) How does thoracic kyphosis affect patient outcomes in growing rod surgery? Spine 37(15):1303–1309

    Article  Google Scholar 

  18. Chen Z, Qiu Y, Zhu Z, Li S, Chen X, Sun X (2017) How does hyperkyphotic early-onset scoliosis respond to growing rod treatment? J Pediatr Orthop 37(8):e593–e598

    Article  Google Scholar 

  19. Mazda K, Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Penneçot GF (2009) Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the universal clamp. Eur Spine J 18(2):158–169

    Article  Google Scholar 

  20. Bekmez S, Demirkiran HG, Dede O, Atici Y, Balioglu MB, Kruyt M, Ward T, Yazici M (2019) Spinal instrumentation in growing children retards the natural development of pelvic incidence. J Pediatr Orthop 39(3):141–145

    Article  Google Scholar 

  21. Inaparthy P, Queruz JC, Bhagawati D, Thakar C, Subramanian T, Nnadi C (2016) Incidence of proximal junctional kyphosis with magnetic expansion control rods in early onset scoliosis. Eur Spine J 25(10):3308–3315

    Article  CAS  Google Scholar 

  22. Erdoğan S, Polat B, Atıcı Y, Özyalvaç ON, Öztürk Ç (2019) Comparison of the effects of magnetically controlled growing rod and traditional growing rod techniques on the sagittal plane in the treatment of early-onset scoliosis. J Korean Neurosurg Soc 62(5):577–585

    Article  Google Scholar 

  23. Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA (2005) Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine 30(17 Suppl):S46-57

    Article  Google Scholar 

  24. Li WJ, Sun ZJ, Guo SG, Qiu GX, Zhang JG, Shen JX, Wang YP, Zhao H, Li SG, Zhao Y (2016) The effect of growing Rod treatment on coronal balance during serial lengthening surgeries in early onset scoliosis. BMC Musculoskelet Disord 12(17):158

    Article  Google Scholar 

  25. Carender CN, Morris WZ, Poe-Kochert C, Thompson GH, Son-Hing JP, Liu RW (2016) Low pelvic incidence is associated with proximal junctional kyphosis in patients treated with growing rods. Spine 41(9):792–797

    Article  Google Scholar 

  26. Kwan KYH, Alanay A, Yazici M, Demirkiran G, Helenius I, Nnadi C et al (2017) Unplanned reoperations in magnetically controlled growing rod surgery for early onset scoliosis with a minimum of two-year follow-up. Spine 42(24):E1410–E1414

    Article  Google Scholar 

  27. Choi E, Yaszay B, Mundis G et al (2017) Implant complications after magnetically controlled growing rods for early onset scoliosis: a multicenter retrospective review. J Pediatr Orthop 37(8):e588–e592

    Article  Google Scholar 

  28. Lonner BS, Ren Y, Newton PO, Shah SA, Samdani AF, Shufflebarger HL, Asghar J, Sponseller P, Betz RR, Yaszay B (2017) Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis-the pelvis and other considerations. Spine Deform 5(3):181–188

    Article  Google Scholar 

Download references

Funding

None of the authors received financial support for this study.

Author information

Authors and Affiliations

  1. Pediatric Orthopaedic Surgery Department, Robert Debré University Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, 48 Bd Sérurier, 75019, Paris, France

    Brice Ilharreborde, Louise Ponchelet & Anne-Laure Simon

  2. Department of Pediatric Orthopaedic and Plastic Surgery, Children University Hospital, Toulouse University, 330 Avenue de Grande Bretagne, 31059, Toulouse, France

    Jérôme Sales de Gauzy

  3. Department of Pediatric Orthopaedic Surgery, La Timone University Hospital, Assistance Publique – Hôpitaux de Marseille (AP-HM), Marseille University, 278 Rue Saint Pierre, 13005, Marseille, France

    Elie Choufani & Sébastien Pesenti

  4. Department of Pediatric Surgery, Jeanne de Flandre University Hospital, Lille University, 2 Avenue Oscar Lambret, 59000, Lille, France

    Matthieu Baudoux

Authors
  1. Brice Ilharreborde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Ponchelet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jérôme Sales de Gauzy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elie Choufani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthieu Baudoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sébastien Pesenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne-Laure Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: BI; administrative support: ALS; provision of study material and patients: BI, JSdeG, EC, MB, SP; collection and assembly of data: LP and ALS; data analysis and interpretation: BI, LP, ALS; manuscript writing: all authors. Final approval of manuscript: All authors.

Corresponding author

Correspondence to Brice Ilharreborde.

Ethics declarations

Conflict of interest

All authors have completed the ICMJE uniform disclosure form. Pr. B Ilharreborde is a consultant for Zimmer Biomet and Implanet. The remaining authors have no conflicts of interest to declare.

Ethical approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the institutional board and informed consent was taken from all the patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ilharreborde, B., Ponchelet, L., Sales de Gauzy, J. et al. How does magnetically controlled growing rods insertion affect sagittal alignment in ambulatory early onset scoliosis patients?. Eur Spine J 31, 1036–1044 (2022). https://doi.org/10.1007/s00586-021-07071-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-07071-0

Keywords

Search

Navigation